Healthcare Provider Details

I. General information

NPI: 1841489200
Provider Name (Legal Business Name): MID-ILLINOIS MEDICAL CARE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2007
Last Update Date: 06/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 N MAPLE ST
EFFINGHAM IL
62401-2005
US

IV. Provider business mailing address

1207 NETWORK CENTRE DR STE 3
EFFINGHAM IL
62401-2186
US

V. Phone/Fax

Practice location:
  • Phone: 217-347-7030
  • Fax: 217-347-7049
Mailing address:
  • Phone: 217-347-2707
  • Fax: 217-347-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EUGENE P. DUST
Title or Position: PRESIDENT OF LLC
Credential: M.D.
Phone: 217-347-5917